Large truck crashes are a significant public health hazard, with fifty percent leading to loss of life or debilitating injuries, according to the Federal Motor Carrier Administration's (FMCSA) Large Truck Crash Study. The truck driver was deemed to be at fault in 87% of these crashes, and in 7% the driver admitted to falling asleep while driving. Truck accidents result in over 5200 fatalities every year and greater than 125,000 injuries. These numbers are likely only a small portion of the actual number of truck crashes due to driver fatigue. Obstructive sleep apnea is a common condition among commercial vehicle drivers, with a prevalence estimated to be somewhere between 17% to 28%. Given that there are roughly 14 million commercial drivers license holders in the United states, somewhere between 2.4 and 3.9 million of these drivers are predicted to suffer from OSA.

Unfortunately, OSA often remains unrecognized or unreported by professional drivers and their employers, as well as undiagnosed by physicians. OSA can considerably increase a driver’s possibility of driving drowsy. Sleepiness and inattention contribute to a considerable number of CMV crashes each year and increases the potential of an individual developing substantial health problems such as hypertension, stroke, ischemic heart disease, and mood disorders. Studies suggest that commercial motor vehicle (CMV) operators have a higher prevalence of OSA than the general population. The chance of having sleep apnea depended on two important variables - age and degree of obesity - with prevalence increasing with both. Population projections by FMCSA indicate the number of older drivers will increase by 50% over the next twenty years. Therefore, determining which truck drivers are most prone to excessive daytime sleepiness (EDS) should be a key public safety priority.

U.S. federal statute requires commercial motor vehicle drivers to undergo medical qualification examinations no less than every 2 years—This section states that the driver must have "no established medical history or clinical diagnosis of respiratory dysfunction likely to interfere with the ability to control and drive a commercial motor vehicle safely." However, the FMCSA medical examination form only includes a single question on sleep problems, though strong economic incentives exist for drivers to deny a history or symptoms of a sleep disorder. Actually, recent studies have demonstrated that only 15% answered yes on the single sleep-related question on the driver medical evaluation form amongst individuals subsequently proven to have substantial OSA.

To be able to address these problems, a consensus document was published by the American College of Chest Physicians, the American College of Occupational and Environmental Medicine, and the National Sleep Foundation. This provided recommendations based on a thorough literature evaluation to assist medical examiners in detecting drivers who might have OSA, and thus who may possibly require a sleep study, both to protect the long-term health of the driver and to ensure public safety on the highways. The recommendations consist of:

1. definition of sleep apnea;

2. present regulations, recommendations, and guidelines;

3. identification of patients at risk of sleep apnea and diagnosis;

4. objective assessment of sleepiness and performance;

5. identification of CMV drivers with sleep apnea who are at high risk for crashes;

6. management of sleep apnea in the CMV driver;

7. practical considerations;

8. additional investigation questions.

In one recent medical literature report, out of 134 sleep study results obtained because of the consensus standards, 94.8% of the individuals had OSA. This researcher also reviewed 10 large truck crashes resulting from driver loss of vehicle control for which the carrier is being sued for at least 1 million dollars. Of those ten, their evaluation of the CDME medical examinations prior to the crash suggests that no less than 4 out of the 10 would have been required to get tested for OSA by the consensus criteria.

These recommendations suggest certifying a driver at lower threat for sleep apnea for a maximum of 3 months, pending a medical evaluation (in-service evaluations), while drivers with more extreme risk factors or a motor vehicle crash most likely related to sleep disturbances must be prohibited from returning to work until they receive a medical evaluation (out-of-service evaluations.) Furthermore, the task force suggests expanding the screening process to involve a far more extensive medical history, flagging such risk factors as bmi, neck circumference, family background of OSA, and history of comorbidities. For those diagnosed with sleep apnea, experts strongly recommend utilizing positive airway pressure for no less than 4 hours within a 24-hour period via a machine that is able to measure time on pressure. Existing guidelines don't specify minimum use of positive airway pressure.

Not only will the driver and the public at large benefit from these recommendations, but a large scale recent clinical investigation has already proven substantial rewards to the employer by virtue of lowering medical costs, reduced absenteeism, improved productivity, as well as fewer accidents.